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OB 1 Lecture 1 Ovarian Menstrual Cycle, Endometrium and Decidua

Dr. J. Mariano
Mikey Silverman

Menstruation process of endometrial tissue shedding with hemorrhage (and
mucus to some degree) that is dependent on sex steroid hormone-directed
changes in blood flow in the spiral arteries. Why is it important that women
menstruate every month? The purpose of the ovarian and endometrial cycles is
to prepare the endometrium for pregnancy.


OVARIAN CYCLE
Complex Interaction between:
o Hypothalamic-Pituitary axis
o Ovaries
o Genital Tract (includes uterus)
Matured HPO axis accounts for regularity of menstrual cycles
Hypothalamus (GnRH) Pituitary (FSH, LH) Ovaries (Estrogen,
Progesterone)
Average cycle: 28 days
Range: 25-32 days

6 days prior to onset of menstruation
o Recruitment of follicles, 20 follicles will be stimulated by FSH.
o Dominant Follicle the follicle receiving most of the FSH
Has its oocyte extruded during ovulation
Waits for sperm for fertilization

Follicular Phase - Preovulatory
o Phase of recruitment of follicles from the resting pool
o Cohort selected group of follicles responding to the FSH levels; growth
to the antral stage


o Two-cell; Two-Gonadotropin Theory
The requirement for thecal cells that respond to LH and granulosa cells
that respond to FSH
LH (left panel) controls theca cell production of androstenedione,
which goes into adjacent granulose cells and acts as a precursor for
estradiol biosynthesis.
The capacity for granulose cell to convert androstenedione to estradiol
is controlled by FSH.
Cholesterol steroid of all the steroid hormones that will be produced
by the ovaries.
Explains polycystic ovarian syndrome excess of adipose tissue which
is converted to extra estrogen, one of the causes of polycystic
ovaries.

Ovulation
Ovulation sets in when you have enough estrogen to tell the hypothalamus
to secrete more GnRH Pituitary (FSH, LH)
Gonadotropin Surge 34-36 hrs before ovulation
Peak of LH secretion 10-12 hrs before ovulation
Recruitment of follicular fluid from granulosa cells
Oocyte is pushed towards periphery breaks and oocyte is released
Stigma of follicular wall reduced Ruptures Oocyte-cumulus complex
acted upon by progesterone and prostaglandins

Luteal Phase postovulatory
Formation of corpus luteum
Angiogenesis and Neovascularization brought about by endothelial growth
factor
Pregnancy corpus luteum continues production of progesterone in
response to embryonic hCG
No Pregnancy corpus luteum regresses 9-11 days after ovulation.
o Decreased levels of LH
o Decreased LH sensitivity of luteal cells
If corpus luteum is present on ovaries, ovulation has occurred, tell patient
she is fertile.
Decreased steroid hormones + Regression of corpus luteum = menstruation

ESTROGEN
17 estradiol most biologically potent
o Secreted by the granulose cells of dominant follicle and luteinized
granulosa cells of the corpus luteum.
o Involves Estrogen Receptor and Estrogen Receptor
Roles
o Synthesis of proteins from receptor-specific gene transcription
o Stimulates nitric acid production in endothelial cells
o Replication of the endometrium
ER seen in endometrium
ER seen in glands and stroma

PROGESTERONE
Counterpart of estrogen, abundant in luteal phase
Mediated through nuclear hormonal receptors
o PR and PR
Most characteristic is subnuclear vacuolation

ENDOMETRIAL CYCLE
Proliferative Phase preovulatory
Day 5 restoration and revascularization of the endometrium
o Glands will go from narrowed to plump
Reepithelialization and angiogenesis has to happen to stop the bleeding
o Woman bleeds for 5-7 days, there has to e a regrowth of the epithelial
lining for the bleeding to stop. A high dose of estrogen grows back
endothelium for patients who bleed for longer periods of time.
This phase dependent on tissue growth
Dependent on estrogen
o Induces growth factor gene expression in stromal cells
o Increases vascular endothelial growth for angiogenesis
Characterized by hyperplasia and increased stromal ground substance
o Variable (5-7 days; 21-30 days)
Secretory Phase postovulatory
Luteal/Secretory phase is constant in duration 12-14 days
Dating based on histology of glandular endothelium
Day 17 glycogen accumulation; subnuclear vacuolation;
pseudostratification
o First sign of ovulation; direct result of progesterone action
Day 18 vacuoles moved to the apical portion
Day 19 Glycoprotein and mucopolysaccharide contents released; mitotic
activity ceases
Day 21-24 stroma becomes edematous
o Days 20-24 - Window of implantation
Best time for blastocyst to implant
Pinopods protrusion of apical surface in to the lumen, present to
assist in implantation
Continuing growth of spiral arteries
You have to have more spiral arteries to increase vasculature
for nutrition from mother to baby
Day 22-25 stromal mitosis apparent

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